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Atrial Fibrillation During Pregnancy
Study Questions:
What is the incidence and impact of atrial fibrillation (AF) and flutter (AFL) during pregnancy among women with heart disease?
Methods:
Pregnant women with a history of structural heart disease were enrolled in a prospective European registry from 2008 to 2011. Patients were recruited from 60 hospitals in 28 countries. Patients with a history of arrhythmias in the absence of heart disease were excluded.
Results:
Among 1,321 pregnant women, AF or AFL was noted in 17 patients (1.3%). The incidence of atrial arrhythmias peaked at the end of the second trimester. A prior history of AF, use of beta-blockers, mitral valve disease, and left-sided congenital lesions were found to be associated with the development of AF during pregnancy (on univariate analysis). Death occurred in two patients (one due to a likely thromboembolic event, and sepsis in another), both of whom had mitral stenosis. AF/AFL was also associated with a low birth weight.
Conclusions:
The authors concluded that AF during pregnancy is uncommon among women with structural heart disease, but is associated with maternal mortality and low fetal birth weight.
Perspective:
Management of AF during pregnancy is challenging due to well-known factors. Given the risk of maternal mortality and unfavorable fetal outcomes, it is probably best to try to prevent AF and its consequences. For example, patients with significant mitral stenosis should be considered for balloon valvuloplasty prior to considering pregnancy. Such resources may not be widely available, however.
Keywords: Adrenergic beta-Antagonists, Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Heart Conduction System, Infant, Low Birth Weight, Maternal Mortality, Mitral Valve Stenosis, Pregnancy, Sepsis, Thromboembolism
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